Meta-Analysis of 123I-MIBG Cardiac Scintigraphy for the Diagnosis of Lewy Body-Related Disorders
Meta-Analysis of 123I-MIBG Cardiac Scintigraphy for the Diagnosis of Lewy Body-Related Disorders
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DOI：
10.1002/mds.23659
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发表时间：
2011-06-01
影响因子：
8.6
通讯作者：
Royall, Donald R.
中科院分区：
文献类型：
--
作者：
King, Alisha E.;Mintz, Jim;Royall, Donald R.
帕金森综合征患者的诊断是一个挑战。帕金森病可能难以与多系统萎缩和进行性核上性麻痹区分，而帕金森病和路易体痴呆可能难以与阿尔茨海默病和其他痴呆区分。许多研究发现，路易体相关疾病（帕金森病和路易体痴呆）的心脏I-123-间碘-苄胍摄取减少。2005年，路易体痴呆症协会认为，基于有限的证据，I-123-间碘苄胍心脏血管造影术是一种“连续性”诊断特征。我们报告了文献的荟萃分析，并评估了I-123-间碘苄胍诊断路易体痴呆和帕金森病的实用性。对1950年至2010年6月期间发表的文章进行了检索。46项涉及神经精神和运动障碍的研究，包括2680例受试者，被纳入分析。采用混合效应回归模型分析I-123-间碘苄胍摄取的延迟平均心脏-纵隔比率。I-123-间碘苄胍心脏血管造影敏感地检测并特异性区分了2个诊断簇：（1）帕金森病、路易体痴呆和快速眼动睡眠行为障碍;（2）正常对照和阿尔茨海默病、多系统萎缩、进行性核上性麻痹、血管性痴呆和额颞叶痴呆患者。在1.77的聚类判别心脏-纵隔比率阈值下，受试者工作特征曲线下面积为0.987。这个阈值产生了94%的灵敏度和91%的特异性，这些诊断集群的歧视。I-123-间碘苄胍心脏闪烁扫描可以准确区分2种运动障碍、帕金森病和多系统萎缩，以及痴呆症的2种常见病因、阿尔茨海默病和路易体痴呆。(C)2011年运动障碍协会
Patients with parkinsonism pose a diagnostic challenge. Parkinson's disease may be difficult to distinguish from multiple system atrophy and progressive supranuclear palsy, whereas Parkinson's disease and dementia with Lewy bodies can be difficult to distinguish from Alzheimer's disease and other dementias. A number of studies have found diminished cardiac I-123-metaiodo-benzylguanidine uptake in Lewy body-related conditions (Parkinson's disease and Lewy body dementia). In 2005, the Dementia With Lewy Bodies Consortium considered I-123-metaiodobenzylguanidine cardiac scintigraphy a "supportive'' diagnostic feature, based on limited evidence. We report a meta-analysis of the literature and an assessment of the utility of I-123-metaiodobenzylguanidine for the diagnosis of dementia with Lewy bodies and Parkinson's disease. A search was conducted of articles published between 1950 and June 2010. Forty-six studies involving neuropsychiatric and movement disorders, comprising 2680 subjects, were included in the analysis. A mixed-effects regression model was used to analyze the delayed mean heart-to-mediastinum ratio of I-123-metaiodobenzylguanidine uptake. I-123-metaiodobenzylguanidine cardiac scintigraphy sensitively detected and specifically distinguished 2 diagnostic clusters: (1) Parkinson's disease, dementia with Lewy bodies, and rapid eye movement sleep behavior disorder; and (2) normal controls and patients with Alzheimer's disease, multiple system atrophy, progressive supranuclear palsy, vascular dementia, and frontotemporal dementia. The area under the receiver operating characteristic curve was 0.987 at a cluster discriminatory heart-to-mediastinum ratio threshold of 1.77. This threshold yielded 94% sensitivity and 91% specificity for the discrimination of these diagnostic clusters. I-123-metaiodobenzylguanidine cardiac scintigraphy can accurately distinguish between 2 movement disorders, Parkinson's disease and multiple system atrophy, and between 2 common causes of dementia, Alzheimer's disease and dementia with Lewy bodies. (C) 2011 Movement Disorder Society